Now that the Affordable Care Act has survived its Supreme Court challenge, there comes the fight over its implementation. Moral considerations rank high on the list of casus belli for Catholics and other religious groups. They fear that the Act will force them to pay for procedures which they abhor, like the morning-after pill, abortion, and sterilisation. The price of resistance could be “institutional martyrdom”, according to University of Notre Dame law professor Gerard Bradley.

He is not alone in his forebodings. The Archbishop of Chicago, Cardinal Francis George, has said that “The long-term effect is that the Catholic Church will be stripped of the institutions that are her instruments for public service. We will lose hospitals, we will lose universities.”

Is their alarm justified? Or is all this just huffing and puffing by embittered losers? Only time will tell, but there are precedents for a war between the Catholic Church and a democratic government. The paradigm case is the Kulturkampf – the culture war – waged by the Iron Chancellor of Prussia, Otto von Bismarck, in the 1870s. The differences are obvious -- President Obama does not make a habit of wearing spiked Prussian helmets -- but there are thought-provoking parallels as well.

Throughout the 19th century Church and State were often at loggerheads, even in European countries with centuries of Catholic tradition behind them. Enlightenment progressives everywhere favoured a radically secularised society in which religion played only a marginal role. In Prussia, the forerunner state to modern Germany, this problem burst a gasket in 1871.

Bismarck’s life’s work was the unification, through conquest and treaty, of an archipelago of German-speaking states (with the conspicuous exception of Austria). In 1870 Prussia humiliated France in the Franco-German War. Bismarck’s army took Emperor Napoleon III prisoner and starved Paris into submission. The Prussians did a triumphal march through the streets of Paris. Bismarck was on a roll. In 1871 the hold-out states of southern Germany joined a Prussian-led federation with Kaiser Wilhelm I as head of state. In many ways this prosperous new country was authoritarian, but it was also a democracy with active political parties.

Even in the flush of triumph, however, the master politician saw problems ahead. As Prussia expanded and became Germany, it lost its original character – a highly-centralised, largely Protestant state. Catholics – mostly in the Rhineland, southern Germany and in the Polish-speaking East – now constituted about a third of the new nation. Bismarck believed that he needed to press hard for unity of language, religion and education, drawing all of society under government control.

In this, he was supported by liberals who detested the Catholic Church as the archetypal foe of progress. It was the famous scientist and social reformer Rudolph Virchow who gave Bismarck’s “reforms” the name Kulturkampf. He praised them as “a great struggle in the interest of humanity" which would eliminate medieval traditionalism, obscurantism, and authoritarianism.